The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion
Background: Chronic total occlusion (CTO) is the most challenging subset in percutaneous coronary intervention (PCI), but the optimal selection of patients and indication for such procedures remain a subject of debate. We sought to investigate the role of physiological function in treatment decision...
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Elsevier
2024-11-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602224001204 |
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| author | Shufu Chang Rende Xu Hao Lu Yuxiang Dai Chenguang Li Jie Zhang Gang Zhao Juying Qian Jianying Ma Junbo Ge |
| author_facet | Shufu Chang Rende Xu Hao Lu Yuxiang Dai Chenguang Li Jie Zhang Gang Zhao Juying Qian Jianying Ma Junbo Ge |
| author_sort | Shufu Chang |
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| description | Background: Chronic total occlusion (CTO) is the most challenging subset in percutaneous coronary intervention (PCI), but the optimal selection of patients and indication for such procedures remain a subject of debate. We sought to investigate the role of physiological function in treatment decisions of CTO PCI by measuring fractional flow reserve (FFR) and Dynamic SPECT imaging in this study. Methods: All the FFR of CTO vessel were measured before and immediately after CTO revascularization, and Dynamic SPECT imaging were detected before PCI in patients with an identified CTO. Results: A total of 53 patients with single-vessel CTO lesions were included in this cohort study. The mean FFR value was 0.34 ± 0.09 at baseline. Immediately after successful CTO PCI, the FFR value significantly increased to 0.79 ± 0.11. The regional coronary flow reserve (CFR) of CTO vessels was 1.62 ± 0.64, which was significantly and positively correlated with the baseline FFR value (r = 0.607, p = 0.005). The area under the ROC curve of the baseline FFR for the detection of ischemia was 0.923 (p < 0.001). The diagnostic performance in terms of sensitivity and specificity was 83.3 % and 85.7 % for baseline FFR with a ROC-optimized cutoff value of 0.35. Conclusions: A significant correlation was found between the CFR derived from dynamic SPECT and baseline FFR. An FFR of <0.35 before CTO PCI can be taken as the cutoff for the presence of inducible ischemia, which was a useful index for therapy options. |
| format | Article |
| id | doaj-art-1e29dfb74edc4051b1a6f68f3aea0f4a |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-1e29dfb74edc4051b1a6f68f3aea0f4a2024-11-14T04:32:50ZengElsevierAmerican Heart Journal Plus2666-60222024-11-0147100477The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusionShufu Chang0Rende Xu1Hao Lu2Yuxiang Dai3Chenguang Li4Jie Zhang5Gang Zhao6Juying Qian7Jianying Ma8Junbo Ge9Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Nuclear Medicine, Fudan University, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; Corresponding author at: No. 180, Fenglin Road, Shanghai 200032, China.Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, ChinaBackground: Chronic total occlusion (CTO) is the most challenging subset in percutaneous coronary intervention (PCI), but the optimal selection of patients and indication for such procedures remain a subject of debate. We sought to investigate the role of physiological function in treatment decisions of CTO PCI by measuring fractional flow reserve (FFR) and Dynamic SPECT imaging in this study. Methods: All the FFR of CTO vessel were measured before and immediately after CTO revascularization, and Dynamic SPECT imaging were detected before PCI in patients with an identified CTO. Results: A total of 53 patients with single-vessel CTO lesions were included in this cohort study. The mean FFR value was 0.34 ± 0.09 at baseline. Immediately after successful CTO PCI, the FFR value significantly increased to 0.79 ± 0.11. The regional coronary flow reserve (CFR) of CTO vessels was 1.62 ± 0.64, which was significantly and positively correlated with the baseline FFR value (r = 0.607, p = 0.005). The area under the ROC curve of the baseline FFR for the detection of ischemia was 0.923 (p < 0.001). The diagnostic performance in terms of sensitivity and specificity was 83.3 % and 85.7 % for baseline FFR with a ROC-optimized cutoff value of 0.35. Conclusions: A significant correlation was found between the CFR derived from dynamic SPECT and baseline FFR. An FFR of <0.35 before CTO PCI can be taken as the cutoff for the presence of inducible ischemia, which was a useful index for therapy options.http://www.sciencedirect.com/science/article/pii/S2666602224001204Chronic total occlusionFractional flow reserveCoronary flow reserveDynamic SPECTPercutaneous coronary intervention |
| spellingShingle | Shufu Chang Rende Xu Hao Lu Yuxiang Dai Chenguang Li Jie Zhang Gang Zhao Juying Qian Jianying Ma Junbo Ge The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion American Heart Journal Plus Chronic total occlusion Fractional flow reserve Coronary flow reserve Dynamic SPECT Percutaneous coronary intervention |
| title | The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion |
| title_full | The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion |
| title_fullStr | The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion |
| title_full_unstemmed | The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion |
| title_short | The evaluation of combined fractional flow reserve and dynamic SPECT in chronic total occlusion |
| title_sort | evaluation of combined fractional flow reserve and dynamic spect in chronic total occlusion |
| topic | Chronic total occlusion Fractional flow reserve Coronary flow reserve Dynamic SPECT Percutaneous coronary intervention |
| url | http://www.sciencedirect.com/science/article/pii/S2666602224001204 |
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